Implementation

• Following intubation and when cardiopulmonary bypass can be rapidly initiated, all patients should receive a test dose at least 10 min before loading dose to determine potential for hypersensitivity reactions. Administer an antihistamine 15 min before test dose to patients with a history of previous exposure to aprotinin. If an allergic reaction occurs after test dose, do not administer further aprotinin. Even with a negative response to the test dose, anaphylaxis may occur with full therapeutic dose

» All doses should be administered through central line

» Administer loading dose with patient in supine position. Loading dose is administered after induction of anesthesia but before sternotomy. Follow loading dose with a continuous infusion until surgery is completed and patient leaves operating room

• Loading Dose: Administer loading dose undiluted

• Rate: Administer loading dose over 20–30 min. Rapid administration may cause transient fall in blood pressure

• Continuous Infusion: Administer undiluted

• Rate: Administer at a rate of 50 ml/hr for the high-dose regimen or 25 mg/hr for the low-dose regimen

• Y-Site Incompatibility: Do not administer any other drug in the same venous line or catheter

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